As many home health agencies see their censuses drop amid the COVID-19 health crisis, it’s more important than ever to ensure that your coding and billing are correct the first time. Here are some home health coding and billing tips to help ensure accuracy and success during these difficult times.
Know your codes and when to use them.
The CDC released an update to ICD-10-CM to address COVID-19 related codes. These codes are effective April 1, 2020 through September 30, 2020.
Code only confirmed and presumptive positive COVID-19 test results as “confirmed” and assign code U07.1, “COVID-19.” A presumptive positive result means the patient has tested positive locally, but the CDC hasn’t confirmed the results. If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID19, you’ll need to assign a code to explain the reason for encounter, such as fever, or Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
During pregnancy, code O98.51, “Other viral diseases complicating pregnancy (by trimester),” should be used to capture COVID-19, not U07.1. When COVID-19 affects childbirth, use code O98.52, “Other viral disease complicating childbirth.” If the mother is postpartum and tests positive for COVID-19, code O98.53, “Other viral disease complicating puerperium, should be assigned.”
Acute Respiratory Illness
When you’ve confirmed acute respiratory illness due to COVID-19, you’ll assign code U07.1 and then the following:
- Pneumonia: J12.89, “Other viral pneumonia”
- Acute bronchitis: J20.8, “Acute bronchitis due to other specified organisms”
- Bronchitis not otherwise specified (NOS): J40, “Bronchitis, not specified as acute or chronic”
- Lower respiratory infection: J22, “Unspecified acute lower respiratory infection”
- Respiratory infection NOS: J98.8, “Other specified respiratory disorders”
- Acute respiratory distress syndrome: J80, “Acute respiratory distress syndrome”
COVID-19 Screening & Exposure
Screening of an asymptomatic person with no known exposure to COVID-19 that results in a negative or unknown test result should be assigned Z11.59, “Encounter for screening for other viral diseases.”
When there’s concern about COVID exposure, but it’s ruled out after evaluation, you should assign code Z03.818, “Encounter for observation for suspected exposure
to other biological agents ruled out.” If there is actual exposure to a confirmed/suspected person, but the test result is negative or unknown, use Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
Accurately sequence the codes.
If COVID-19 is the principal diagnosis, code U07.1 should be first. Follow this by all other appropriate codes.
Don’t wait for orders from a supervising physician.
Don’t wait for home health orders from a supervising physician to admit a patient or submit your bills to Medicare. The CARES Act authorizes physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists to order home health care services.
Many agencies have seen a decrease in face-to-face visits because patients are declining visits or the visits are being replaced by telehealth. As a result, agencies are seeing an increase in LUPAs (Low Utilization Payment Adjustment). To minimize LUPAs, communicate patient-specific LUPA thresholds to your entire care team. Also, regularly communicate with your patients to avoid potential scheduling issues that could result in missed visits. Lastly, train your staff to re-schedule immediately and if that clinician is not available, to work with other available clinicians to make it up.
Carefully manage visits within each of the two 30-day windows to avoid LUPAs. A LUPA threshold will apply to each 30-day payment episode. Be aware that the threshold can change from one payment period to the next. Watch for tapering visits during the second 30-day payment episode, as this could lead to a potential LUPA.
We Can Help!
Home health coding and billing continue to increase in difficulty. With the introduction of PDGM and now the current public health emergency, getting it right the first time is critical to your success. Our billing, coding, and OASIS review experts are certified and highly experienced in navigating the complexities of home health. We stay up-to-date on the latest changes and guidelines as they occur. As a result, you can trust us to reduce documentation errors and expedite claims. If you’re currently outsourcing or considering it for the first time, contact us to learn more about how we stand out from the competition. Reach out to us today.